Clinical and Demographic Predictors of Late-Stage Cervical Cancer

Ferrante, Joan M.; Gonzalez, Eduardo; Roetzheim, Richard G.; Pal, Naazneen; Woodard, Laurie

doi:10.1001/archfami.9.5.439

Cited by 75 publications

(69 citation statements)

References 43 publications

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“…Education has been linked to level of resources, cognition, and reception of health education messages (7,17); thus, the increased risk for advanced cancer of women with shorter education might be related to insufficient knowledge about cervical cancer and the prevention opportunities. Danish studies of cancers at other sites also found that shorter education was associated with more advanced cancer (20)(21)(22)(23), whereas studies of cervical cancer patients in New York City (n ¼ 2,930) and Florida (n ¼ 852) showed no association with education after adjustment for income and marital status (9,10). However descriptive statistics from the Florida study (9) and from a study in 5 U.S. states and 5 metropolitan areas (13) showed that women with short education were more likely to have regional spread cancer than women with higher education (37% vs. 51% and 31% vs. 38%, respectively).…”

Section: Discussionmentioning

confidence: 98%

“…Most of the previous studies of the effects of social factors on timing of cervical cancer diagnosis were conducted in the United States, used area-based measures of socioeconomic position, or focused on racial or ethnic differences (8)(9)(10)(11)(12)(13). We conducted a nationwide population-based study, with individual information on social indicators, to investigate the influence of socioeconomic position on stage at diagnosis of cervical cancer and, in addition, whether comorbidity and time since last Papanicolau (Pap) smear mediated this potential association.…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic Position and Stage of Cervical Cancer in Danish Women Diagnosed 2005 to 2009

Ibfelt

Kjær

Johansen

et al. 2012

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: To reduce social disparities in cervical cancer survival, it is important to understand the mechanisms by which social position influence cancer prognosis. We investigated the relations between socioeconomic factors, comorbidity, time since last Papanicolau smear, and stage at diagnosis in Danish women with cervical cancer. Results: The risk for advanced (stage II-IV) compared with early-stage cancer (stage I) was increased for women with short and medium education (OR ¼ 2.40; 1.67-3.45 and 1.76; 1.44-2.16), women living without a partner (OR ¼ 1.31; 1.10-1.55), and older women (OR ¼ 1.07; 1.06-1.08 increase per year). The relations between socioeconomic factors and cancer stage were partly mediated by time since last Pap smear test and to a lesser extent by comorbidity.Conclusions: Shorter education, living alone, and older age were related to advanced stage cervical cancer, due partly to Pap smear testing and less to comorbidity.Impact: It is relevant to further investigate how to decrease delay in cervical cancer diagnosis among disadvantaged groups. Cancer Epidemiol Biomarkers Prev; 21(5); 835-42. Ó2012 AACR.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Socioeconomic Position and Stage of Cervical Cancer in Danish Women Diagnosed 2005 to 2009

Ibfelt

Kjær

Johansen

et al. 2012

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…30 There are other reports claiming that gynaecological cancers continue to represent a significant problem in the elderly. 22,31 As regards genitourinary tumours, the much poorer prognosis of older patients could be due to an inverse significant relationship of stage to age, and the complexity of surgical procedures as well as the particular physiological role of kidney. In addition, both bladder and kidney cancers have cigarette smoking as common etiologic factor and patients suffering from these tumours are often affected also by comorbid conditions, such as cardiovascular and pulmonary diseases which can mask the cancer symptoms and delay, or in someway vary, the time of diagnosis.…”

Section: Differences In Survival By Age: the Role Of Cancer Sitementioning

confidence: 99%

A wide difference in cancer survival between middle aged and elderly patients in Europe

Quaglia¹,

Capocaccia²,

Micheli³

et al. 2007

Intl Journal of Cancer

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Nowadays the burden of cancer in elderly people has reached an alarming extent. The purpose of this study is comparing cumulative and conditional relative survival in elderly patients between 65 and 84 years and younger adults aged from 55 to 64. Fifty-three cancer registries of 22 European countries, participating in the EUROCARE-3 programme, collected information on the cases diagnosed over the period [1990][1991][1992][1993][1994]. We computed cumulative and conditional relative survival for 16 cancer sites. Middle aged patients experienced a better prognosis than the elderly for all cancer sites, in both sexes and the differences were more marked at 1 than 5 years since diagnosis. The very large differences noted in the first period after cancer detection declined in the subsequent years and, when 5-years conditional survival was considered, for several cancers the elderly and younger adults had the same probabilities of surviving. The death relative excess risks (RERs) in the elderly with respect younger individuals were really very high and markedly larger at 1 than 5 years, and in women than men. Genitourinary and gynaecological cancers showed the highest RERs, around 2.0 and between 1.5 and 2.5 respectively. This very high early mortality could be due not only to clinical aspects: the barriers to health care access and a consequent late diagnosis might represent for elderly patients the main determinant of this very large prognostic disadvantage. In conclusion, clinical management of cancer in the elderly remains a major issue to be faced with complex social and health care policies. ' 2007 Wiley-Liss, Inc.Key words: cancer; conditional and cumulative relative survival; health care inequalities; elderly Western populations are rapidly ageing; this phenomenon has accelerated at least since the early 80 s. Now the magnitude of this issue has reached an alarming extent and the burden of chronic diseases like cancer requires an extraordinary effort by health care systems and social services.According to data by the United Nations, in 2000 the elderly over 65 years amounted in Northern, Western and Southern Europe to about 13-14% and 18-19% of all resident population in men and in women respectively. The phenomenon will reach a peak when the people born during the period of the ''baby boom'', in the 50-60 s, will be 65 years old. For instance, in Italy, the country with the highest proportion of people aged 65 years or over (15% in men and 21% in women), by 2030 this population segment will represent 29% and 35% of total population. In this demographic context the cancer burden is quickly increasing; on one hand incidence and mortality trends of some major cancers are levelling off or declining, on the other hand crude rates are growing as a consequence of people ageing. If we consider the single European macro-regions in 2002, we observe very variant situations: in Eastern countries only 49% in men and 48% in women of all cancers were detected in the elderly, the corresponding values increased to 67% and 58%...

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“…Incidence rates among these minority populations (2)(3)(4)(5)(6)(7)(8) and those who are uninsured (1,(9)(10)(11) have remained relatively stable for the past several years (12)(13), suggesting that system characteristics are likely preventing population health improvement.…”

Section: Introductionmentioning

confidence: 99%

Increasing Efforts to Reduce Cervical Cancer through State-Level Comprehensive Cancer Control Planning

Meyerson

Zimet

Multani

et al. 2015

Cancer Prevention Research

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Reducing cervical cancer disparities in the United States requires intentional focus on structural barriers such as systems and policy that impact access to human papillomavirus (HPV) vaccination, cervical cancer screening, and treatment. Such changes are difficult and often politicized. State comprehensive cancer control (CCC) plans are vehicles that, if designed well, can help build collective focus on structural changes. Study objectives were to identify the prioritization of cervical cancer in state CCC plans, the conceptualization of HPV within these plans, and the focus of plans on structural changes to reduce cervical cancer disparities. Data were gathered by systematic content analysis of CCC plans from 50 states and the District of Columbia from February-June 2014 for evidence of cervical cancer prioritization, conceptualization of HPV, and focus on structural barriers to cervical cancer vaccination, screening or treatment. Findings indicate that prioritization of cervical cancer within state CCC plans may not be a strong indicator of state efforts to reduce screening and treatment disparities. While a majority of plans reflected scientific evidence that HPV causes cervical and other cancers, they did not focus on structural elements impacting access to evidence-based interventions. Opportunities exist to improve state CCC plans by increasing their focus on structural interventions that impact cervical cancer prevention, detection, and treatment, particularly for the 41% of plans ending in 2015 and the 31% ending between 2016 and 2020. Future studies should focus on the use of policy tools in state CCC plans and their application to cervical cancer prevention and treatment. Cancer Prev Res; 8(7); 636-41. Ó2015 AACR.

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Clinical and Demographic Predictors of Late-Stage Cervical Cancer

Abstract: Women with cervical cancer who are elderly, unmarried, and uninsured are more likely to be diagnosed at a late stage. These women should be targeted for cervical cancer education and screening programs.

Cited by 75 publications

References 43 publications

Socioeconomic Position and Stage of Cervical Cancer in Danish Women Diagnosed 2005 to 2009

Socioeconomic Position and Stage of Cervical Cancer in Danish Women Diagnosed 2005 to 2009

A wide difference in cancer survival between middle aged and elderly patients in Europe

Increasing Efforts to Reduce Cervical Cancer through State-Level Comprehensive Cancer Control Planning

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